Methods for fabricating polymer-bioceramic composite implantable medical devices

ABSTRACT

Methods relating to polymer-bioceramic composite implantable medical devices are disclosed.

CROSS REFERENCE TO RELATED APPLICATION

This application is a divisional application of U.S. patent applicationSer. No. 12/895,618 which was filed on Sep. 30, 2010, which is adivisional of U.S. patent application Ser. No. 11/706,550 which wasfiled on Feb. 14, 2007, now abandoned, both of which are incorporated byreference herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to methods of fabricating implantable medicaldevices.

2. Description of the State of the Art

This invention relates to radially expandable endoprostheses, which areadapted to be implanted in a bodily lumen. An “endoprosthesis”corresponds to an artificial device that is placed inside the body. A“lumen” refers to a cavity of a tubular organ such as a blood vessel.

A stent is an example of such an endoprosthesis. Stents are generallycylindrically shaped devices, which function to hold open and sometimesexpand a segment of a blood vessel or other anatomical lumen such asurinary tracts and bile ducts. Stents are often used in the treatment ofatherosclerotic stenosis in blood vessels. “Stenosis” refers to anarrowing or constriction of the diameter of a bodily passage ororifice. In such treatments, stents reinforce body vessels and preventrestenosis following angioplasty in the vascular system. “Restenosis”refers to the reoccurrence of stenosis in a blood vessel or heart valveafter it has been treated (as by balloon angioplasty, stenting, orvalvuloplasty) with apparent success.

The treatment of a diseased site or lesion with a stent involves bothdelivery and deployment of the stent. “Delivery” refers to introducingand transporting the stent through a bodily lumen to a region, such as alesion, in a vessel that requires treatment. “Deployment” corresponds tothe expanding of the stent within the lumen at the treatment region.Delivery and deployment of a stent are accomplished by positioning thestent about one end of a catheter, inserting the end of the catheterthrough the skin into a bodily lumen, advancing the catheter in thebodily lumen to a desired treatment location, expanding the stent at thetreatment location, and removing the catheter from the lumen.

In the case of a balloon expandable stent, the stent is mounted about aballoon disposed on the catheter. Mounting the stent typically involvescompressing or crimping the stent onto the balloon. The stent is thenexpanded by inflating the balloon. The balloon may then be deflated andthe catheter withdrawn. In the case of a self-expanding stent, the stentmay be secured to the catheter via a constraining member such as aretractable sheath or a sock. When the stent is in a desired bodilylocation, the sheath may be withdrawn which allows the stent toself-expand.

The stent must be able to satisfy a number of mechanical requirements.First, the stent must be capable of withstanding the structural loads,namely radial compressive forces, imposed on the stent as it supportsthe walls of a vessel. Therefore, a stent must possess adequate radialstrength. Radial strength, which is the ability of a stent to resistradial compressive forces, is due to strength and rigidity around acircumferential direction of the stent. Radial strength and rigidity,therefore, may also be described as, hoop or circumferential strengthand rigidity.

Once expanded, the stent must adequately maintain its size and shapethroughout its service life despite the various forces that may come tobear on it, including the cyclic loading induced by the beating heart.For example, a radially directed force may tend to cause a stent torecoil inward. Generally, it is desirable to minimize recoil. Inaddition, the stent must possess sufficient flexibility to allow forcrimping, expansion, and cyclic loading. Longitudinal flexibility isimportant to allow the stent to be maneuvered through a tortuousvascular path and to enable it to conform to a deployment site that maynot be linear or may be subject to flexure. Finally, the stent must bebiocompatible so as not to trigger any adverse vascular responses.

The structure of a stent is typically composed of scaffolding thatincludes a pattern or network of interconnecting structural elementsoften referred to in the art as struts or bar arms. The scaffolding canbe formed from wires, tubes, or sheets of material rolled into acylindrical shape. The scaffolding is designed so that the stent can beradially compressed (to allow crimping) and radially expanded (to allowdeployment). A conventional stent is allowed to expand and contractthrough movement of individual structural elements of a pattern withrespect to each other.

Additionally, a medicated stent may be fabricated by coating the surfaceof either a metallic or polymeric scaffolding with a polymeric carrierthat includes an active or bioactive agent or drug. Polymericscaffolding may also serve as a carrier of an active agent or drug.

Furthermore, it may be desirable for a stent to be biodegradable. Inmany treatment applications, the presence of a stent in a body may benecessary for a limited period of time until its intended function of,for example, maintaining vascular patency and/or drug delivery isaccomplished. Therefore, stents fabricated from biodegradable,bioabsorbable, and/or bioerodable materials such as bioabsorbablepolymers should be configured to completely erode only after theclinical need for them has ended.

A potential problem with polymeric stents is that their struts or bararms can crack during crimping and expansion. This is especially thecase with brittle polymers. The localized portions of the stent patternsubjected to substantial deformation during crimping and expansion tendto be the most vulnerable to failure.

Therefore, it is desirable for a stent to have flexibility andresistance to cracking during deployment. It is also advantageous for astent to be rigid and resistant to creep after deployment. It would alsobe desirable to be able to control the degradation rate of the device.

SUMMARY OF THE INVENTION

Various embodiments of the present invention include a method forfabricating an implantable medical device comprising: forming asuspension solution including a fluid, a polymer and bioceramicparticles, wherein the polymer is dissolved in the fluid, and whereinthe bioceramic particles are dispersed in the solution; evaporating atleast some of the fluid to remove at least some of the polymer from thesuspension solution, wherein at least some of the bioceramic particlesare removed with the removal of polymer to form a composite mixture, thecomposite mixture comprising the removed bioceramic particles dispersedwithin the removed polymer; and fabricating an implantable medicaldevice from the composite mixture.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts a three-dimensional view of a stent.

FIG. 2A depicts a section of a structural element from the stentdepicted in FIG. 1.

FIG. 2B depicts bioceramic particles dispersed within a polymer matrix.

FIG. 3 depicts a schematic plot of the crystal nucleation rate, thecrystal growth rate, and the overall rate of crystallization for asemicrystalline polymer.

FIG. 4A-C depicts an exemplary system and process for forming acomposite mixture

FIG. 5A-B depicts an exemplary system and process for forming acomposite mixture

FIG. 6A-B depicts an exemplary system and process for forming acomposite mixture

FIG. 7 is a graph depicting the peak stress for PLLA and PLLA/HAPcomposites.

FIG. 8 is a graph depicting the break strain for PLLA and PLLA/HAPcomposites.

FIG. 9 is a graph depicting Young's modulus for PLLA and PLLA/HAPcomposite stent in compression testing.

FIG. 10 is a graph depicting the radial stress for PLGA and PLGA/HAPcomposite stent in compression testing.

FIG. 11 is a graph depicting the compression modulus for PLGA andPLGA/HAP composite stent in compression testing.

FIG. 12 is a graph depicting recoil testing of PLGA and PLGA/HAPcomposite stent.

FIGS. 13A-D depict photographic images of a PLGA/calcium sulfatecomposite stent with a weight ratio of PLGA/calcium sulfate of 100:1 atzero time point.

FIGS. 14A-D depict photographic images of a PLGA/calcium sulfatecomposite stent with a weight ratio of PLGA/calcium sulfate of 100:1 at16 hours of accelerated aging.

DETAILED DESCRIPTION OF THE INVENTION

Those of ordinary skill in the art will realize that the followingdescription is of the invention is illustrative only and not in any waylimiting. Other embodiments of the invention will readily suggestthemselves to such skilled persons based on the disclosure herein. Allsuch embodiments are within the scope of this invention.

For the purposes of the present invention, the following terms anddefinitions apply:

The “glass transition temperature,” Tg, is the temperature at which theamorphous domains of a polymer change from a brittle vitreous state to asolid deformable or ductile state at atmospheric pressure. In otherwords, the Tg corresponds to the temperature where the onset ofsegmental motion in the chains of the polymer occurs. When an amorphousor semicrystalline polymer is exposed to an increasing temperature, thecoefficient of expansion and the heat capacity of the polymer bothincrease as the temperature is raised, indicating increased molecularmotion. As the temperature is raised the actual molecular volume in thesample remains constant, and so a higher coefficient of expansion pointsto an increase in free volume associated with the system and thereforeincreased freedom for the molecules to move. The increasing heatcapacity corresponds to an increase in heat dissipation throughmovement. Tg of a given polymer can be dependent on the heating rate andcan be influenced by the thermal history of the polymer. Furthermore,the chemical structure of the polymer heavily influences the glasstransition by affecting mobility.

“Stress” refers to force per unit area, as in the force acting through asmall area within a plane. Stress can be divided into components, normaland parallel to the plane, called normal stress and shear stress,respectively. True stress denotes the stress where force and area aremeasured at the same time. Conventional stress, as applied to tensionand compression tests, is force divided by the original gauge length.

“Strength” refers to the maximum stress along an axis which a materialwill withstand prior to fracture. The ultimate strength is calculatedfrom the maximum load applied during the test divided by the originalcross-sectional area.

“Modulus” may be defined as the ratio of a component of stress or forceper unit area applied to a material divided by the strain along an axisof applied force that results from the applied force. For example, amaterial has both a tensile and a compressive modulus. A material with arelatively high modulus tends to be stiff or rigid. Conversely, amaterial with a relatively low modulus tends to be flexible. The modulusof a material depends on the molecular composition and structure,temperature of the material, amount of deformation, and the strain rateor rate of deformation. For example, below its Tg, a polymer tends to bebrittle with a high modulus. As the temperature of a polymer isincreased from below to above its Tg, its modulus decreases.

“Strain” refers to the amount of elongation or compression that occursin a material at a given stress or load.

“Elongation” may be defined as the increase in length in a materialwhich occurs when subjected to stress. It is typically expressed as apercentage of the original length.

“Toughness” is the amount of energy absorbed prior to fracture, orequivalently, the amount of work required to fracture a material. Onemeasure of toughness is the area under a stress-strain curve from zerostrain to the strain at fracture. Thus, a brittle material tends to havea relatively low toughness.

“Solvent” is defined as a substance capable of dissolving or dispersingone or more other substances or capable of at least partially dissolvingor dispersing the substance(s) to form a uniformly dispersed solution atthe molecular- or ionic-size level. The solvent should be capable ofdissolving at least 0.1 mg of the polymer in 1 ml of the solvent, andmore narrowly 0.5 mg in 1 ml at ambient temperature and ambientpressure.

As used herein, an “implantable medical device” includes, but is notlimited to, self-expandable stents, balloon-expandable stents,stent-grafts, implantable cardiac pacemakers and defibrillators; leadsand electrodes for the preceding; implantable organ stimulators such asnerve, bladder, sphincter and diaphragm stimulators, cochlear implants;prostheses, vascular grafts, grafts, artificial heart valves andcerebrospinal fluid shunts.

An implantable medical device can be designed for the localized deliveryof a therapeutic agent. A medicated implantable medical device may beconstructed by coating the device with a coating material containing atherapeutic agent. The substrate of the device may also contain atherapeutic agent.

FIG. 1 depicts a three-dimensional view of stent 100. In someembodiments, a stent may include a pattern or network of interconnectingstructural elements 110. Stent 100 may be formed from a tube (notshown). Stent 100 includes a pattern of structural elements 110, whichcan take on a variety of patterns. The structural pattern of the devicecan be of virtually any design. The embodiments disclosed herein are notlimited to stents or to the stent pattern illustrated in FIG. 1. Theembodiments are easily applicable to other patterns and other devices.The variations in the structure of patterns are virtually unlimited. Astent such as stent 100 may be fabricated from a tube by forming apattern with a technique such as laser cutting or chemical etching.

The geometry or shape of an implantable medical device may varythroughout its structure to allow radial expansion and compression. Apattern may include portions of structural elements or struts that arestraight or relatively straight, an example being a portion 120. Inaddition, patterns may include structural elements or struts thatinclude curved or bent portions such as portions 130, 140, and 150.

An implantable medical device can also be made partially or completelyfrom a biodegradable, bioabsorbable, or biostable polymer. A polymer foruse in fabricating an implantable medical device can be biostable,bioabsorbable, biodegradable or bioerodable. Biostable refers topolymers that are not biodegradable. The terms biodegradable,bioabsorbable, and bioerodable are used interchangeably and refer topolymers that are capable of being completely degraded and/or erodedwhen exposed to bodily fluids such as blood and can be graduallyresorbed, absorbed, and/or eliminated by the body. The processes ofbreaking down and absorption of the polymer can be caused by, forexample, hydrolysis and metabolic processes.

However, polymers tend to have a number of shortcomings for use asmaterials for implantable medical devices such as stents. Manybiodegradable polymers have a relatively low modulus at thephysiological conditions in the human body. In general, compared tometals, the strength to weight ratio of polymers is smaller than that ofmetals. A polymeric stent with inadequete radial strength can result inmechanical failure or recoil inward after implantation into a vessel. Tocompensate for the relatively low modulus, a polymeric stent requiressignificantly thicker struts than a metallic stent, which results in anundesirably large profile.

Another shortcoming of polymers is that many polymers, such asbiodegradable polymers, tend to be brittle under physiologicalconditions or conditions within a human body. Specifically, suchpolymers can have a Tg above human body temperature which isapproximately 37° C. These polymer systems exhibit a brittle fracturemechanism in which there is little or no plastic deformation prior tofailure. As a result, a stent fabricated from such polymers can haveinsufficient toughness for the range of use of a stent.

Other potential problems with polymeric stents include creep, stressrelaxation, and physical aging. Creep refers to the gradual deformationthat occurs in a polymeric construct subjected to an applied load. Creepoccurs even when the applied load is constant.

It is believed that the delayed response of polymer chains to stressduring deformation causes creep behavior. As a polymer is deformed,polymeric chains in an initial state rearrange to adopt a newequilibrium configuration. Rearrangement of chains takes place slowlywith the chains retracting by folding back to their initial state. Forexample, an expanded stent can retract radially inward, reducing theeffectiveness of a stent in maintaining desired vascular patency. Therate at which polymers creep depends not only on the load, but also ontemperature. In general, a loaded construct creeps faster at highertemperatures.

Stress relaxation is also a consequence of delayed molecular motions asin creep. Contrary to creep, however, which is experienced when the loadis constant, stress relaxation occurs when deformation (or strain) isconstant and is manifested by a reduction in the force (stress) requiredto maintain a constant deformation.

Physical aging, as used herein, refers to densification in the amorphousregions of a semi-crystalline polymer. Densification is the increase indensity of a material or region of a material. Densification, and thusphysical aging, is also the result of relaxation or rearrangement ofpolymer chains.

Various embodiments of the present invention include an implantablemedical device fabricated from a composite including a polymer matrix orcontinuous phase and bioceramic particles as a discrete phase. Thebioceramic particles may tend to reduce or eliminate a number of theabove-mentioned shortcomings of polymers. For example, the bioceramicparticles can increase the toughness and modulus and modify thedegradation rate of the polymer. In some embodiments, the composite mayinclude a plurality of bioceramic particles dispersed within thepolymer.

In general, it is desirable for the bioceramic particles to be uniformlydispersed throughout the biodegradable polymer. The more uniform thedispersion of the particles results in more uniform properties of thecomposite and a device fabricated from the composite. For example, auniform dispersion can result in a uniform increase in toughness andmodulus and modification of degradation rate. In some embodiments, thebioceramic particles are uniformly or substantially uniformly dispersedwithin the biodegradable polymer.

In certain embodiments, a structural element of an implantable medicaldevice may be fabricated from a bioceramic/polymer composite. Structuralelements can include, but are not limited to, any supporting elementsuch as a strut, wire, or filament. FIG. 2A depicts a section 200 of astructural element 110 from stent 100. A portion 210 of section 200 isshown in an expanded view in FIG. 2B. FIG. 2B depicts bioceramicparticles 220 dispersed throughout a polymer matrix 230.

Bioceramics can include any ceramic material that is compatible with thehuman body. More generally, bioceramic materials can include any type ofcompatible inorganic material or inorganic/organic hybrid material.Bioceramic materials can include, but are not limited to, calciumsulfate, alumina, zirconia, apatites, calcium phosphates, silica basedglasses, or glass ceramics, and pyrolytic carbons. Bioceramic materialscan be bioabsorbable and/or active. A bioceramic is active if itactively takes part in physiological processes. A bioceramic materialcan also be “inert,” meaning that the material does not absorb ordegrade under physiological conditions of the human body and does notactively take part in physiological processes.

Illustrative examples of apatites and other calcium phosphates, include,but are not limited hydroxyapatite (Ca₁₀(PO₄)₆(OH)₂), floroapatite(Ca₁₀(PO₄)₆F₂), carbonate apatide (Ca₁₀(PO₄)₆CO₃), tricalcium phosphate(Ca₃(PO₄)₂), octacalcium phosphate (Ca₈H₂(PO₄)₆-5H₂O), octacalciumphosphate (Ca₈H₂(PO₄)₆-5H₂O), calcium pyrophosphate (Ca₂P₂O₇.2H₂O),tetracalcium phosphate (Ca₄P₂O₉), and dicalcium phosphate dehydrate(CaHPO₄.2H₂O).

The term bioceramics can also include bioactive glasses that arebioactive glass ceramics composed of compounds such as SiO₂, Na₂O, CaO,and P₂O₅. For example, a commercially available bioactive glass,Bioglass®, is derived from certain compositions ofSiO₂—Na2O—K₂O—CaO—MgO—P₂O₅ systems. Some commercially availablebioactive glasses include, but are not limited to:

45S5: 46.1 mol % SiO2, 26.9 mol % CaO, 24.4 mol % Na₂O and 2.5 mol %P₂O₅;

58S: 60 mol % SiO2, 36 mol % CaO, and 4 mol % P₂O₅; and

S70C30: 70 mol % SiO2, 30 mol % CaO.

Another commercially available glass ceramic is A/W.

In some embodiments, bioceramic particles in a composite implantablemedical device may be used to inhibit or prevent infection since somebioceramics can have an anti-infective property. Bioceramics may releasevarious ions such as calcium and phosphate ions which broadly exist inhuman body fluid and blood plasma. Examples of bioceramics that releasecalcium and/or phosphate ions include various calcium phosphates andbioactive glasses. The released ions may depress foreign body reaction.Trends Biomater. Artif. Tren, Vol 18 (1), pp 9-17.

As indicated above, an implantable medical device such as a stent can bemedicated by incorporating an active agent in a coating over the deviceor within the substrate of the device. In some embodiments, the ionsreleased from bioceramics can have an additive therapeutic and/or asynergistic therapeutic effect to the active agent. For example, ionscan be used in conjunction with anti-proliferative and/oranti-inflammatory agents.

Bioceramic particles can be partially or completely made from abiodegradable, bioabsorbable, or biostable ceramic. Examples ofbioabsorbable bioceramics include various types of bioglass materials,tetracalcium phosphate, amorphous calcium phosphate, alpha-tricalciumphosphate, and beta-tricalcium phosphate. Biostable bioceramics includealumina and zirconia.

Various sizes of the bioceramic particles may be used in the composite.For example, the bioceramic particles can include, but are not limitedto, nanoparticles and/or micro particles. A nanoparticle refers to aparticle with a characteristic length (e.g., diameter) in the range ofabout 1 nm to about 1,000 nm. A micro particle refers to a particle witha characteristic length in the range of greater than 1,000 nm and lessthan about 10 micrometers. Additionally, bioceramic particles can be ofvarious shapes, including but not limited to, spheres and fibers.

Additionally, the particles size distribution can be important inmodifying the properties of the polymer. Generally, a narrow sizedistribution is preferable.

The composite of a structural element of a device may have between 0.01%and 10% of bioceramic particles by weight, or more narrowly, between0.5% and 2% bioceramic particles by weight as compared to the polymermatrix of the composite.

As indicated above, the bioceramic particles can reduce or eliminate anumber of shortcomings of polymers that are used for implantable medicaldevices. In one aspect of the invention, bioceramic particles canincrease the fracture toughness of polymers of implantable medicaldevice. In general, the higher the fracture toughness, the moreresistant a material is to the propagation of cracks. In someembodiments, bioceramic particles may be used in a composite having amatrix polymer that is brittle at physiological conditions. Inparticular, such a polymer can have a Tg above body temperature. In oneembodiment, the bioceramic particles may be nanoparticles.

Certain regions of an implantable medical device, such as a stent,experience a high degree of stress and strain when the device is understress during use. For example, when a stent is crimped and deployed,curved or bending regions such as portions 130, 140, and 150 can havehighly concentrated strain which can lead to fracture. The bioceramicparticles can increase fracture toughness by reducing the concentrationof strain by dispersing the strain over a large volume of the material.Particles can absorb energy due to applied stress and disperse energyabout a larger volume in the bioceramic/polymer composite.

Therefore, rather than being highly concentrated the stress and strainin a device fabricated from a bioceramic composite is divided into manysmall interactions involving numerous individual particles. When a crackis initiated in the material and starts traveling through the composite,the crack breaks up into finer and finer cracks due to interaction withthe particles. Thus, the particles tend to dissipate the energy ofimparted to the device by the applied stress. In general, the increasein the toughness is directly proportional to the size of the particles.For a give weight ratio of particles to matrix, as the size of theparticles decreases the number of particles dispersed throughout thedevice per unit volume also increases. Thus, the number of particles todisperse the energy of applied stress to the device increases.Therefore, it is advantageous to use nanoparticles to increase thetoughness of the polymer. It has been shown that the fracture toughnessof a polymeric material can be improved by using nanoparticles as adiscrete or reinforcing phase in a composite. J. of Applied PolymerScience, 94 (2004) 796-802.

Bioceramic particles, more particularly nano-bioceramic particles, byproviding more crystallites in a network in the bioceramic/polymercomposite increase fracture toughness.

In yet another aspect of the invention, bioceramic particles can be usedto increase the modulus of the polymer. As indicated above, a polymericstent requires a high radial strength in order to provide effectivescaffolding of a vessel. Many biodegradable polymers have a relativelylow modulus as compared to metals. A composite with bioceramic particleswith a higher modulus than a matrix polymer may have a higher modulusthan the polymer. The higher modulus may allow for the manufacture of acomposite stent with much thinner struts than a stent fabricated fromthe matrix polymer alone. Examples of relatively low modulus polymersinclude, but are not limited to, poly(D,L-lactide-co-glycolide),poly(lactide-co-caprolactone), poly(lactide-co-trimethylene carbonate),poly(glycolide-co-caprolactone), and poly(D,L-lactide). It has beenreported that composites with nanoparticles can increase the modulus ofa polymer by 1-2 orders of magnitude. Mechanical Properties of Polymersand Composites, Lawrence E. Nielsen and Robert F. Landel, 2^(nd) ed., p.384-385 (1993).

In addition, bioceramic particles in a polymer composite can also reduceor eliminate creep, stress relaxation, and physical aging. It isbelieved that particles can act as “net point” that reduce or inhibitmovement of polymer chains in amorphous regions of a polymer.

Additionally, in composites fabricated from semicrystalline polymers,the crystallinity of a bioceramic/polymer composite that forms animplantable device can be controlled to reduce or eliminate creep,stress relaxation, and physical aging. As indicated above, thesephenomena in a polymer are due to rearrangement or relaxation of polymerchains.

In general, as the crystallinity of a semicrystalline polymer increases,physical aging creep, and stress relaxation are reduced. This is likelydue to the fact that polymer chains in the amorphous domains capable ofmovement are reduced by the crystalline domains. However, increasingcrystallinity can result in brittleness in a polymer at physiologicalconditions.

In further embodiments, a structural element of an implantable medicaldevice may include a composite having a plurality of crystalline domainsdispersed within an amorphous biodegradable polymeric matrix phase. Thecrystalline domains may be formed around bioceramic particles. Incertain embodiments, the composite that makes up the structural elementmay have a relatively low crystallinity. For example, the crystallinitycan be less than 50%, 30%, 20%, or less than 10%.

Additionally, the device can be fabricated so that the resultingcomposite has a relatively large number of crystalline domains that arerelatively small. In certain embodiments, the average crystal size canbe less than 10 microns, 5 microns, or less than 2 microns. As the sizeof the crystalline domains decreases along with an increase in thenumber of domains, the polymer may become less brittle and, whichincreases the fracture toughness. Although the crystallinity of theresulting polymer can be relatively low, the presence of the relativelylarge number of relatively small crystalline domains can reduce oreliminate physical aging, creep, and stress relaxation.

The size and number of crystallites domains can be controlled duringformation of a polymer construct from an implantable medical device isfabricated. Polymer constructs, such as tubes, can be formed usingvarious types of forming methods, including, but not limited toextrusion or injection molding. Representative examples of extrudersinclude, but are not limited to, single screw extruders, intermeshingco-rotating and counter-rotating twin-screw extruders, and othermultiple screw masticating extruders.

In some embodiments, a mixture of a polymer and bioceramic particles canbe extruded to form a polymer construct, such as a tube. A polymer meltmixed with the bioceramic particles can be conveyed through an extruderand forced through a die in the shape of as an annular film in the shapeof a tube. The annular film can be cooled below the melting point, Tm,of the polymer to form an extruded polymeric tube. For example, theannular film may be conveyed through a water bath at a selectedtemperature. Alternatively, the annular film may be cooled by a gas at aselected temperature. The annular film may be cooled at or near anambient temperature, e.g. 25° C. Alternatively, the annular film may becooled at a temperature below ambient temperature.

In general, crystallization in a polymer tends to occur in a polymer attemperatures between Tg and Tm of the polymer. Therefore, in someembodiments, the temperature of the polymer construct during cooling canbe between Tg and Tm. As the temperature of the extruded mixture iscooled below Tm to form a polymer construct, such as a tube, thebioceramic particles provide a point of nucleation in the polymer meltfor the formation of crystalline domains.

A network of many small crystalline domains is formed, which can work totie crystalline domains together and reduce, inhibit or preventfracturing, creep, stress relaxation, and physical aging of the polymer.The crystalline domains can serve as net points in the amorphous domainsthat restrict the freedom of movement of polymer chains in the amorphousdomain. As a result, physical aging, creep, and stress relaxation can bereduced. In addition, for the reasons discussed above, the toughness ofthe polymer is also increased.

In general, both microparticles and nanoparticles can be used asnucleation points. However, as the number of particles increases andsize of the particles decreases, the crystalline domains become moreeffective in increasing fracture toughness and reducing physical aging,creep, and stress relaxation. The closer the crystalline domains are toone another within the amorphous domain of a polymer, the more thecrystalline domains can limit the degree of freedom movement of polymerchains in the amorphous domain. Therefore, nanoparticles may be moreeffective in reducing physical aging, creep, and stress relaxation.

In certain embodiments, the size of the crystalline domains can becontrolled by the temperature of the cooling polymer construct from anextruder. In general, crystallization tends to occur in a polymer attemperatures between Tg and Tm of the polymer. The rate ofcrystallization in this range varies with temperature. FIG. 3 depicts aschematic plot of the crystal nucleation rate (R_(N)), the crystalgrowth rate (R_(CG)), and the overall rate of crystallization (R_(CO)).The crystal nucleation rate is the growth rate of new crystals and thecrystal growth rate is the rate of growth of formed crystals. Theoverall rate of crystallization is the sum of curves R_(N) and R_(CG).

In certain embodiments, the temperature of the cooling polymer constructcan be at a temperature at which the overall crystallization rate isrelatively low. At such a temperature, the increase in crystallinity ispredominantly due to formation of crystalline domains around thebioceramic particles, rather than the growth of existing crystals. Insome embodiments, the temperature can be in a range in which the crystalnucleation rate is larger than the crystal growth rate. In oneembodiment, the temperature can be in a range in which the crystalnucleation rate is substantially larger than the crystal growth rate.For example, the temperature can be where the ratio of the crystalnucleation rate to crystal growth rate is 2, 5, 10, 50, 100, or greaterthan 100. In another embodiment, the temperature range may be in range,ΔT, shown in FIG. 3, between about Tg to about 0.25(Tm−Tg)+Tg.

In general, good bonding between a continuous phase and a discrete orreinforcing phase in a composite material facilitates improvement of themechanical performance of the composite. For example, increase of themodulus and fracture toughness of a polymer due to a bioceramic particlephase can be enhanced by good bonding between the polymer and particles.

In some embodiments, bioceramic particles may include an adhesionpromoter to improve the adhesion between the particles and the polymermatrix. In one embodiment, an adhesion promoter can include a couplingagent. A coupling agent refers to a chemical substance capable ofreacting with both the bioceramic particle and the polymer matrix of thecomposite material. A coupling agent acts as an interface between thepolymer and the bioceramic particle to form a chemical bridge betweenthe two to enhance adhesion.

The adhesion promoter may include, but is not limited to, silane andnon-silane coupling agents. For example, the adhesion promoter mayinclude 3-aminopropyltrimethoxysilane, 3-aminopropyltriethoxysilane,aminopropylmethyldiethoxy silane, organotrialkoxysilanes, titanates,zirconates, and organic acid-chromium chloride coordination complexes.In particular, 3-aminopropyltrimethoxysilane has been shown tofacilitate adhesion between poly(L-lactide) and bioglass. Biomaterials25 (2004) 2489-2500.

In some embodiments, the surface of the bioceramic particles may betreated with an adhesion promoter prior to mixing with the polymermatrix. In one embodiment, the bioceramic particles can be treated witha solution containing the adhesion promoter. Treating can include, butis not limited to, coating, dipping, or spraying the particles with anadhesion promoter or a solution including the adhesion promoter. Theparticles can also be treated with a gas containing the adhesionpromoter. In one embodiment, treatment of the bioceramic particlesincludes mixing the adhesion promoter with solution of distilled waterand a solvent such as ethanol and then adding bioceramic particles. Thebioceramic particles can then be separated from the solution, forexample, by a centrifuge, and the particles can be dried. The bioceramicparticles may then used to form a polymer composite. In an alternativeembodiment, the adhesion promoter can be added to the particles duringformation of the composite. For example, the adhesion promoter can bemixed with a bioceramic/polymer mixture during extrusion.

As indicated above, a device may be composed in whole or in part ofmaterials that degrade, erode, or disintegrate through exposure tophysiological conditions within the body until the treatment regimen iscompleted. The device may be configured to disintegrate and disappearfrom the region of implantation once treatment is completed. The devicemay disintegrate by one or more mechanisms including, but not limitedto, dissolution and chemical breakdown.

The duration of a treatment period depends on the bodily disorder thatis being treated. For illustrative purposes only, in treatment ofcoronary heart disease involving use of stents in diseased vessels, theduration can be in a range from about a month to a few years. However,the duration is typically in a range from about six to twelve months.Thus, it is desirable for an implantable medical device, such as astent, to have a degradation time at or near the duration of treatment.Degradation time refers to the time for an implantable medical device tosubstantially or completely erode away from an implant site.

Several mechanisms may be relied upon for erosion and disintegration ofimplantable devices which include, but are not limited to, mechanical,chemical breakdown and dissolution. Therefore, bodily conditions caninclude, but are not limited to, all conditions associated with bodilyfluids (contact with fluids, flow of fluids) and mechanical forcesarising from body tissue in direct and indirect contact with a device.Degradation of polymeric materials principally involves chemicalbreakdown involving enzymatic and/or hydrolytic cleavage of devicematerial due to exposure to bodily fluids such as blood.

Chemical breakdown of biodegradable polymers results in changes ofphysical and chemical properties of the polymer, for example, followingexposure to bodily fluids in a vascular environment. Chemical breakdownmay be caused by, for example, hydrolysis and/or metabolic processes.Hydrolysis is a chemical process in which a molecule is cleaved into twoparts by the addition of a molecule of water. Consequently, the degreeof degradation in the bulk of a polymer is strongly dependent on thediffusivity, and hence the diffusion rate of water in the polymer.

Another deficiency of some biodegradable polymers, such aspoly(L-lactide), is that the degradation rate is slow and results in adegradation time of a stent outside of the desired range. A preferreddegradation is from six to twelve months. Increasing the equilibriumcontent of moisture in a biodegradable polymer that degrades byhydrolysis can increase the degradation rate of a polymer. Variousembodiments of the present invention include increasing the equilibriummoisture content in a polymer of a device to accelerate the degradationrate.

In some embodiments, bioabsorbable bioceramic particles may be includedin a bioceramic/polymer composite device to increase the degradationtime of the polymer of the device. In an embodiment, the degradationrate of a bioceramic/polymer composite device can be tuned and/oradjusted to a desired time frame. As the bioceramic particle erodeswithin the polymeric matrix, the porosity of the matrix increases. Theincreased porosity increases the diffusion rate of moisture through thepolymeric matrix, and thus, the equilibrium moisture content of thepolymeric matrix. As a result, the degradation rate of the polymer isincreased. The porous structure also increases the transport ofdegradation products out of the matrix, which also increases thedegradation rate of the matrix.

In certain embodiments, the degradation rate and degradation time of thedevice can be tuned or controlled through variables such as the type ofbioceramic material and the size and shape of particles. In someembodiments, bioceramic materials can be selected to have a higherdegradation rate than the polymer matrix. The faster the degradationrate of the bioceramic material, the faster the porosity of the polymermatrix increases which results in a greater increase in the degradationrate of the polymer matrix. Additionally, the size of the particlesinfluence the time for erosion of the particles. The smaller theparticles, the faster the erosion of the particles because of the highersurface area per unit mass of particles.

For example, nanoparticles may have a relatively fast erosion ratecompared to microparticles. Additionally, elongated particles, such asfibers, may tend to erode faster on a per unit mass basis due to thehigher surface area per unit mass of the particle. Also, short fibersmay tend to erode faster than longer fibers. Short fibers refer to longfibers than have been cut into short lengths. In some embodiments, theshort fibers may be made by forming fibers as described above, andcutting them into short lengths. In one embodiment, a length of at leasta portion of the short fibers is substantially smaller than a diameterof the formed tube. For example, in some embodiments, the short fibersmay be less than 0.05 mm long. In other embodiments, the short fibersmay be between 0.05 and 8 mm long, or more narrowly between 0.1 and 0.4mm long or 0.3 and 0.4 mm long.

Furthermore, the size and distribution of pores created by erosion ofbioceramic particles can also influence the degradation rate and time ofthe polymer matrix. Smaller particles, such as nanoparticles, create aporous network that exposes a larger volume of polymer matrix to bodilyfluid than larger particles, like microparticles. As a result thedegradation rate and time of the matrix may be higher when nanoparticlesare used rather than microparticles.

Through appropriate selection of the type of material for the particlesand the size and shape of the particles, the particles and the devicecan be designed to have a selected erosion rates and degradation time.For example, the particles can designed erode away in several minutes,hours, days, or a month upon exposure to bodily fluid.

As indicated above, many biodegradable polymers degrade by the mechanismof hydrolysis. The rate of the hydrolysis reaction tends to increase asthe pH decreases. Since the degradation products of such polymers aspolylactides are acidic, the degradation products have an autocatalyticeffect. Therefore, the pH of the degradation products of the bioceramicscan also affect the degradation rate of a device. Therefore, bioceramicparticles with acidic degradation by-products may further increase therate of degradation of a matrix polymer.

For example, tricalcium phosphate releases acidic degradation products.Thus, some embodiments may include a composite including a bioceramichaving acidic degradation products upon exposure to bodily fluids. Theacidic degradation products can increase the degradation rate of thepolymer which can decrease the degradation time of the device.

In other embodiments, a composite can have bioceramic particles thathave basic degradation products. For example, hydroxyapatite releasesbasic degradation products. The basic degradation products of thebioceramic particles can reduce the autocatalytic effect of the polymerdegradation by neutralizing the acidic degradation products of thepolymer degradation. In some embodiments, the basic degradation productsof the bioceramic particles can reduce the degradation rate of thepolymer. Additionally, bioceramic particles having a basic degradationproduct may also depress foreign body reaction.

For example, in rapidly eroding implantable medical devices, such as,for example poly(lactide-co-glycolide) which can potentially produce alocal pH drop due to the rapid release of acidic degradation products,the use of bioceramic particles having a basic degradation product maybuffer the reaction and neutralize the local pH drop.

Furthermore, some semi-crystalline biodegradable polymers have adegradation rate that is slower than desired for certain stenttreatments. As a result, the degradation time of a stent made from suchpolymers can be longer than desired. For example, a stent made frompoly(L-lactide) can have a degradation time of between about two andthree years. In some treatment situations, a degradation time of lessthan a year may be desirable, for example, between four and eightmonths.

As discussed above, the degradation of a hydrolytically degradablepolymer follows a sequence including water penetration into the polymerfollowed by hydrolysis of bonds in the polymer. Thus, the degradation ofa polymer can be influenced by its affinity for water and the diffusionrate of water through the polymer. A hydrophobic polymer has a lowaffinity for water which results in a relatively low water penetration.In addition, the diffusion rate of water through crystalline regions ofa polymer is lower than amorphous regions. Thus, as either the affinityof a polymer for water decreases or the crystallinity increases, waterpenetration and water content of a polymer decreases.

Further embodiments of a biodegradable implantable medical device may befabricated from a copolymer. In certain embodiments, the copolymer canbe a matrix in a bioceramic/polymer composite. The copolymer can includehydrolytically degradable monomers or functional groups that providedesired degradation characteristics. For instance, the copolymer caninclude functional groups that increase water penetration and watercontent of the copolymer. In some embodiments, a copolymer can include aprimary functional group and at least one additional secondaryfunctional group. In one embodiment, the copolymer may be a randomcopolymer including the primary functional group and at least oneadditional secondary functional group.

In an embodiment, the copolymer with at least one secondary functionalgroup can have a higher degradation rate than a homopolymer composed ofthe primary functional group. A stent fabricated from the copolymer canhave a lower degradation time than a stent fabricated from a homopolymercomposed of the primary functional group.

In an embodiment, the weight percent of the secondary functional groupcan be selected or adjusted to obtain a desired degradation rate of thecopolymer or degradation time of a stent made from the copolymer. Insome exemplary embodiments, the weight percent of the secondaryfunctional group in a copolymer can be at least 1%, 5%, 10%, 15%, 30%,40%, or, at least 50%. In certain exemplary embodiments, a secondaryfunctional group can be selected and the weight percent of the asecondary functional group can be adjusted so that the degradation timeof a stent, with or without dispersed bioceramic particles, can be lessthan 18 months, 12 months, 8 months, 5 months, 3 months, or morenarrowly, less than 1 month.

In some embodiments, the copolymer with at least one secondaryfunctional group can have a lower crystallinity than a homopolymercomposed of the primary functional group. It is believed that inclusionof a secondary functional group can perturb the crystalline structure ofa polymer including the primary functional group, resulting in a reducedcrystallinity. As a result, a stent fabricated from the copolymer has alarger percentage of amorphous regions, which allow greater waterpenetration. Thus, the degradation rate of the copolymer can beincreased and the degradation time of a stent made from the copolymercan be decreased.

In one embodiment, a secondary functional group can be a stereoisomer ofthe primary functional group. One exemplary embodiment can include apoly(L-lactide-co-DL-lactide) copolymer. DL-lactide can be a secondaryfunctional group that perturbs the crystalline structure of thepoly(L-lactide) so that the copolymer has a lower crystallinity than thepoly(L-lactide).

In some embodiments, increasing the number of secondary functionalgroups in the copolymer can result in a decrease in modulus of thecopolymer as compared to a homopolymer of the primary functional group.The decrease in modulus can be due to the decrease in crystallinity. Thedecrease in modulus can reduce the ability of a stent to support avessel. Thus, the weight percent of the secondary functional group canbe adjusted so that the ability of a stent to act as structural supportis not substantially reduced. The inclusion of bioceramic particles inthe copolymer can partially or completely compensate for the reductionin the modulus of the copolymer.

In other embodiments, the copolymer can include at least one secondaryfunctional group with a greater affinity for water than the primaryfunctional group. The secondary functional group can be less hydrophobicor more hydrophilic than the primary functional group. The decreasedhydrophobicity or increased hydrophilicity can increase theconcentration of water near bonds prone to hydrolysis, increasing thedegradation rate and lowering the degradation time of a stent made fromthe copolymer.

In certain embodiments, the secondary functional groups can be selectedso that segments of the copolymer with a secondary functional group candegrade faster than the primary functional group segments. Thedifference in degradation rate can be due to the secondary functionalgroups being more hydrolytically active than the primary functionalgroup. In one embodiment, a secondary functional group can be selectedsuch that a homopolymer including the secondary functional group has ahigher degradation rate than a homopolymer including the primaryfunctional group.

In an exemplary embodiment, the copolymer can bepoly(L-lactide-co-glycolide). The primary functional group can beL-lactide and the secondary functional group can be glycolide. Theweight percent of the glycolide in the copolymer can be at least 1%, 5%,10%, 15%, 30%, 40%, or, at least 50%. In certain exemplary embodiments,the weight percent of glycolide group can be adjusted so that thedegradation time of a stent, with or without dispersed bioceramicparticles, can be less than 18 months, 12 months, 8 months, 5 months, ormore narrowly, 3 months or less.

Further embodiments of the invention include formation of abioceramic/polymer composite and fabrication of an implantable medicaldevice therefrom. As indicated above, a composite of a polymer andbioceramic particles can be extruded to form a polymer construct, suchas a tube. A stent can then be fabricated from the tube. The compositecan be formed in a number of ways. In some embodiments, the compositecan be formed by melt blending. In melt blending the bioceramicparticles are mixed with a polymer melt. The particles can be mixed withthe polymer melt using extrusion or batch processing.

In one embodiment, the bioceramic particles can be combined with apolymer in a powdered or granular form prior to melting of the polymer.The particles and polymer can be mixed using mechanical mixing orstirring such as agitation of the particles and polymer in a containeror a mixer. The agitated mixture can then be heated to a temperatureabove the melt temperature of the polymer in an extruder or using batchprocessing.

However, a problem with the mechanical mixing or stirring techniques isthat the polymer and particles may be separated into separate regions orlayers. This is particularly a problem with respect to smaller particlessuch as nanoparticles. Additionally, obtaining a uniform dispersion bymixing particles with a polymer melt as described, is that particles canagglomerate or form clusters. The mechanical mixing in an extruder or inbatch processing can be insufficient to break up the clusters, resultingin a nonuniform mixture of bioceramic particles and polymer. Someembodiments may include forming a composite from a suspension ofbioceramic particles and a polymer solution. A composite formed using asuspension may result in a composite having more uniformly dispersedparticles than methods formed without using a suspension.

Alternatively, bioceramic particles can be mixed with a polymer bysolution blending in which a composite mixture of bioceramic particlesand polymer is formed from a suspension of particles in a polymersolution. Certain embodiments of a method of forming an implantablemedical device may include forming a suspension including a fluid, apolymer, and bioceramic particles. A “suspension” is a mixture in whichparticles are suspended or dispersed in a fluid. The fluid can be asolvent for the polymer so that the polymer is dissolved in the fluid.The particles can be mixed with the fluid before or after dissolving thepolymer in the fluid.

Various mechanical mixing methods known to those of skill in the art maybe used to disperse the bioceramic particles in the suspension. In oneembodiment, the suspension can be treated with ultrasound, for example,by an ultrasonic mixer. After formation of a suspension, the polymer andbioceramic particles may then removed from the suspension to form a welldispersed composite mixture. The polymer and bioceramic particles can beremoved from the suspension to form the composite mixture in a number ofways. Various embodiments are presented below for forming the compositemixture from the suspension solution.

Some embodiments of forming a composite mixture from the suspension caninclude combining the suspension with a second fluid that may be a poorsolvent for the polymer. At least some of polymer may be allowed toprecipitate upon combining the suspension solution with the secondfluid. In some embodiments, at least some of the bioceramic particlesmay precipitate from the suspension with the precipitated polymer toform a composite mixture.

The precipitated composite mixture may then be filtered out of thesolvents. The filtered composite mixture can be dried to remove residualsolvents. For example, the composite mixture can be dried in a vacuumoven or by blowing heated gas on the mixture.

Exemplary polymers may include, but are not limited to, poly (L-lacticacid), poly (DL-lactic acid), poly (lactide-coglycolide). Representativesolvents for such polymers can include toluene and chloroform.Representative poor solvents for these polymers that may be used toprecipitate the polymer include methanol, ethanol, isopropanol, andvarious alkanes such as hexane or heptane.

It is believed that in a suspension including bioceramic nanoparticles,the particles can have strong interactions with polymer chains insolution which can result in particles becoming encapsulated orsurrounded by polymer chains. Thus, when the polymer is precipitatedfrom the solution, the interactions of the particles with the polymercan overcome interactions of the particles with the solution so that theparticles precipitate with the polymer.

Additionally, it has been observed that the both the degree ofprecipitation of particles and the degree of dispersion of particleswithin the precipitated polymer depends upon the amount of polymerdissolved in the solution. The degree of precipitation refers to theamount of particles that precipitate out of the suspension. The degreeof dispersion of particles within the precipitated polymer refers to thedegree of mixing of the particles with the polymer.

The amount of polymer can be quantified by the weight percent of thepolymer in the suspension solution. In addition, the viscosity of thesolution is also related to the amount of polymer in the solution. Thehigher the weight percent of dissolved polymer, the higher is theviscosity of the suspension solution.

For a given concentration of suspended particles, as weight percent ofdissolved polymer or viscosity is reduced, the degree of precipitationof particles is reduced. This is likely due to the reduced interactionof the particles with the polymer chains. Thus, at lower weight percentof polymer or viscosity, the amount of particles precipitating can berelatively low.

Additionally, for a given concentration of suspended particles, as theweight percent of polymer or viscosity of the solution is increasedbeyond an observed range, the degree of dispersion of particles in theprecipitated polymer tends to decrease. It is believed that at higherweight percent of polymer or higher viscosity, the interactions betweenpolymer chains reduce the interaction of particles with polymer chainsthat cause particles to precipitate. For example, particles may beunable to move freely among the polymer chains.

A given suspension can have a particular combination of type ofparticles, particle concentration, and solvent. For this givensuspension, the polymer weight percent or viscosity that can be variedto obtain both a desired degree of precipitation of particles and degreeof dispersion of particles in the precipitated polymer. Thus, there maybe a range of polymer weight percent or viscosity that can result in adesired degree of precipitation of particles and degree of dispersion ofparticles in precipitated polymer.

Additionally, the manner of combining the suspension with the poorsolvent can also affect the degree of precipitation and degree ofdispersion. For example, depositing a fine mist of small droplets into apoor solvent can more readily result in a desired degree ofprecipitation and degree of dispersion. Thus, the manner of combiningthe suspension with the poor solvent can influence the range of polymerweight percent or viscosity that results in a desired degree ofprecipitation and degree of dispersion.

Further embodiments of forming a composite mixture can includeevaporating at least some of the solvent in the suspension solution. Asthe solvent evaporates, at least some of the polymer may separate orprecipitate from the suspension, and thus be removed from thesuspension. In some embodiments, at least some of the bioceramicparticles may separate from or precipitate from the suspension solutionalong with the polymer upon evaporation the solvent to form thecomposite mixture. In an embodiment, all or substantially all of thesolvent can be evaporated from the suspension, leaving a compositemixture. The evaporation of the solvent can be facilitated by increasingthe temperature of the suspension, for example, by applying heat to thesuspension. Additionally or alternatively, the evaporation of thesolvent can be facilitated by decreasing the pressure of the above thesuspension.

In certain embodiments, the evaporation of the solvent can befacilitated by subjecting the suspension to spray drying which involvesatomizing the suspension or forming a plurality of fine droplets ofsuspension. For example, the suspension can be forced through anatomizing device such as a spray nozzle to form an atomized stream ofdroplets. The increase in surface to volume ratio of the atomizedsuspension increases the rate of the evaporation of the solvent.Additionally, the evaporation of the solvent from the droplets can befurther enhanced by increasing the temperature of the droplets. In oneembodiment, the temperature can be increased by spraying the dropletsinto a stream of heated gas. The temperature can also be controlled byspraying the droplets within a heated chamber. In additionalembodiments, the evaporation of the solvent can be further befacilitated by decreasing the pressure of the droplets. For example, apump in communication with the chamber can reduce the pressure in thechamber below the vapor pressure of the solvent. Additionally, thepressure can be decreased by subjecting the suspension to flashevaporation in which the suspension undergoes a reduction in pressure bypassing it through a throttling valve or other throttling device.

As the solvent in the droplets evaporates, at least some of the polymerseparates from the suspension. Additionally, at least some of thebioceramic particles may be separated along with the polymer uponspraying to form the composite mixture. In an embodiment, processparameters can be adjusted so that all or substantially all of thesolvent evaporates and the composite mixture can be recovered. Processparameters include the size of the droplets, the temperature andpressure in a chamber, the temperature of a heated gas stream,throttling pressure, and the distance between a spray nozzle and arecovery receptacle.

FIG. 4A-C depict an exemplary system and process for forming a compositemixture. FIG. 4A depicts a suspension 405 which is formed in a container410. Suspension 405 includes a polymer solution 415 and bioceramicparticles 420 mixed or suspended in solution 415.

In one embodiment, the suspension can be formed by mixing a solution ofsolvent and surfactant with bioceramic particles 420 by vigorousstirring with a mechanical stirrer 440. A polymer is gradually added tothe suspension during the stirring and stirring is continued at leastuntil all of the polymer is dissolved. In some embodiments, ultrasonicmixing is used to further disperse all the bioceramic particlesuniformly into the polymer matrix.

FIG. 4B depicts a spray-drying apparatus 400 for separating the polymerand particles 420 from solution 415. System 400 includes an atomizingdevice or spray nozzle 445. Suspension 405 is fed into nozzle 445, asshown by an arrow 450, along with an air stream 455. Nozzle 445 producesa spray plume 470 including a plurality of droplets. FIG. 4C shows anexpanded view of a droplet 460 from spray plume 470. As the droplets inspray plume 470 fall away from nozzle 445 as shown by an arrow 480, thesolvent in the droplets evaporates. A heated gas nozzle blows heated gas481 onto spray plume 470 to facilitate evaporation of the solvent in thedroplets. System 400 can be enclosed in a chamber (not shown) so thatthe temperature and pressure can be adjusted to control the rate ofevaporation.

All or substantially all of the solvent evaporates from the dropletsleaving particles 482 of composite mixture of polymer and bioceramicparticles 420. Particles 482 of the composite mixture 470 are collectedin a container 485. The composite mixture formed can be removed forfurther processing to form an implantable medical device.

Further embodiments of forming a composite mixture from the suspensioncan include removal of the solvent from the suspension by forming a twophase liquid system of the suspension solution and another fluid. Insome embodiments, the method may include forming a mixture of thesuspension solution and a second fluid that is a poor solvent for thepolymer and is immiscible with the solvent so that a suspension solutionphase and a second fluid phase is formed. In one embodiment, the solventis an organic fluid and the second fluid is aqueous. At least some ofpolymer may precipitate upon combining the suspension solution with thesecond fluid due to leaching of the solvent into the second fluid phase.In some embodiments, at least some of the bioceramic particles mayprecipitate from the suspension with the precipitated polymer to form acomposite mixture. The precipitated composite mixture can be then beseparated from the liquid phases through filtering or evaporation of theliquid phases. For example, evaporation can be facilitated by atomizinga two liquid phase system in a similar manner as the single liquid phasesystem described above.

In certain embodiments, the leaching of the solvent into the secondfluid phase can be facilitated by forming an emulsion of the solventwithin the second fluid phase. An “emulsion” is a mixture of twoimmiscible substances in which one substance (the dispersed phase) isdispersed in the other (the continuous phase). Thus, the suspensionfluid phase may be dispersed within the second fluid phase. An emulsioncan include a plurality of suspension fluid phase droplets dispersedwithin a second fluid phase. Such an emulsion can be formed usingvigorous high shear mixing devices that are known to one of skill in theart.

FIG. 5A-B depict an exemplary system 500 for forming a composite mixturefrom a two phase liquid system of the suspension solution and an aqueousfluid. A suspension solution 515 is added to a container 505 having anaqueous fluid or phase 510. Suspension solution 515 includes a polymerdissolved in an organic solvent with dispersed bioceramic particles. Theadded suspension solution 515 can form a plurality of droplets of anorganic phase 520 within aqueous phase 510. In FIG. 5B, an expanded viewof organic phase 520 shows bioceramic particles 530 dispersed within anorganic solvent 525. The plurality of droplets of organic phase 520 canbe formed by high shear mixing by a mixing apparatus 535. As organicsolvent 525 leaches out of organic phase 520 into aqueous phase 510,polymer and bioceramic particles separate from the suspension phase toform particles 540 of composite mixture. Particles 540 can be separatedthrough filtration.

FIG. 6A-B depict an exemplary system and process for forming a compositemixture. FIG. 6A depicts a solvent evaporating apparatus 600. Asuspension solution 605, including dissolved polymer and bioceramicparticles mixed or suspended in a solution, is added to solventevaporating system 600. The suspension solution can include a surfactantthat facilitates the dispersion of the particles and reduces or preventsagglomeration of the particles. System 600 includes an atomizing deviceor spray nozzle 610. Suspension solution 605 is fed into nozzle 610,along with an air stream 615. Suspension solution 605 is mixed with anaqueous fluid 620 which is also fed into nozzle 610. Nozzle 610 producesa spray plume 625 including a plurality of droplets that includes anorganic phase 630 within an aqueous phase 620, as shown by droplet 621organic phase 630 includes bioceramic particles 622 in FIG. 6B Asorganic solvent leaches out of organic phase 630 into aqueous phase 620,polymer and bioceramic particles separate from the suspension solutionto form particles 640 of composite mixture. All or substantially all ofthe organic and aqueous phase evaporates from the droplets leavingparticles 640 of composite mixture including polymer and bioceramicparticles. Particles of the composite mixture 640 are collected in acontainer 645. The composite mixture formed can be removed for furtherprocessing to form an implantable medical device.

Further embodiments of the method include conveying the compositemixture into an extruder. The composite mixture may be extruded at atemperature above the melting temperature of the polymer and less thanthe melting temperature of the bioceramic particles. In someembodiments, the dried composite mixture may be broken into small piecesby, for example, chopping or grinding. Extruding smaller pieces of thecomposite mixture may lead to a more uniform distribution of thenanoparticles during the extrusion process.

The extruded composite mixture may then be formed into a polymerconstruct, such as a tube or sheet which can be rolled or bonded to forma tube. A medical device may then be fabricated from the construct. Forexample, a stent can be fabricated from a tube by laser machining apattern in to the tube.

In another embodiment, a polymer construct may be formed from thecomposite mixture using an injection molding apparatus.

Preparation of a desired amount of precipitated composite mixture mayrequire a large amount of solvent and precipitant. Therefore, in someembodiments, it may be advantageous to melt blend precipitated compositemixture with an amount of polymer in an extruder or in a batch process.The polymer can be the same or a different polymer of the precipitatedcomposite mixture. For example, a relatively small amount ofprecipitated composite mixture that has a weight percent of bioceramicparticles higher than is desired can be prepared. The precipitatedcomposite mixture may be melt blended with an amount of biodegradablepolymer to form a composite mixture than has a desired weight percent ofbioceramic particles.

Representative examples of polymers that may be used to fabricate animplantable medical device include, but are not limited to,poly(N-acetylglucosamine) (Chitin), Chitosan, poly(hydroxyvalerate),poly(lactide-co-glycolide), poly(hydroxybutyrate),poly(hydroxybutyrate-co-valerate), polyorthoester, polyanhydride,poly(glycolic acid), poly(glycolide), poly(L-lactic acid),poly(L-lactide), poly(D,L-lactic acid), poly(L-lactide-co-glycolide);poly(D,L-lactide), poly(caprolactone), poly(trimethylene carbonate),polyethylene amide, polyethylene acrylate, poly(glycolicacid-co-trimethylene carbonate), co-poly(ether-esters) (e.g. PEO/PLA),polyphosphazenes, biomolecules (such as fibrin, fibrinogen, cellulose,starch, collagen and hyaluronic acid), polyurethanes, silicones,polyesters, polyolefins, polyisobutylene and ethylene-alphaolefincopolymers, acrylic polymers and copolymers other than polyacrylates,vinyl halide polymers and copolymers (such as polyvinyl chloride),polyvinyl ethers (such as polyvinyl methyl ether), polyvinylidenehalides (such as polyvinylidene chloride), polyacrylonitrile, polyvinylketones, polyvinyl aromatics (such as polystyrene), polyvinyl esters(such as polyvinyl acetate), acrylonitrile-styrene copolymers, ABSresins, polyamides (such as Nylon 66 and polycaprolactam),polycarbonates, polyoxymethylenes, polyimides, polyethers,polyurethanes, rayon, rayon-triacetate, cellulose, cellulose acetate,cellulose butyrate, cellulose acetate butyrate, cellophane, cellulosenitrate, cellulose propionate, cellulose ethers, and carboxymethylcellulose.

Additional representative examples of polymers that may be especiallywell suited for use in fabricating an implantable medical deviceaccording to the methods disclosed herein include ethylene vinyl alcoholcopolymer (commonly known by the generic name EVOH or by the trade nameEVAL), poly(butyl methacrylate), poly(vinylidenefluoride-co-hexafluororpropene) (e.g., SOLEF 21508, available fromSolvay Solexis PVDF, Thorofare, N.J.), polyvinylidene fluoride(otherwise known as KYNAR, available from ATOFINA Chemicals,Philadelphia, Pa.), ethylene-vinyl acetate copolymers, and polyethyleneglycol.

The examples and experimental data set forth below are for illustrativepurposes only and are in no way meant to limit the invention. Thefollowing examples are given to aid in understanding the invention, butit is to be understood that the invention is not limited to theparticular materials or procedures of examples. The bioceramic particlesused in the examples were hydroxyapatite (HAP) and calcium sulfate. Thepolymers used in the Examples were poly (L-lactic acid) (PLLA), poly(DL-lactic acid) (PDLLA), and poly (lactic acid co-glycolide) (PLGA).

Example 1 Prophetic Example of Solution Blending of Polymer andBioceramic Particles

Step 1: Add bioceramic particles into suitable solvent, such aschloroform, acetone, etc. and stir to form a bioceramic particlesuspension solution.

Step 2: Slowly add a polymer such as PLLA, PDLLA, PGLA into suspensionsolution and stir until polymer dissolves completely. In this step, thesolution may still have a relatively low viscosity. However, thebioceramic particles should be well dispersed while stirring.

Step 3: Slowly add the polymer into solution again to gradually increasesolution viscosity. Repeat this step as needed until the polymer iscompletely dissolved and reasonable solution viscosity is developed.

Step 4: Apply ultrasonic mixing to suspension solution for 15-30 min tofurther disperse all the bioceramic particles uniformly into the PLLAsolution.

Step 5: An atomized device is used to flash solvent out or evaporatesolvent out at high pressure and temperature above solvent vaporpressure.

Step 6: Collect the separated, well-dispersed bioceramicparticles/polymer composite mixture.

Example 2 Prophetic Example of Solution Blending of Polymer andBioceramic Particles

Step 1: Add bioceramic particles into suitable solvent, such aschloroform, acetone, etc. and stir to form a bioceramic particlesuspension solution.

Step 2: Slowly add a polymer such as PLLA, PDLLA, PGLA into suspensionsolution and stir until polymer dissolves completely. In this step, thesolution may still have a relatively low viscosity. However, thebioceramic particles should be well dispersed while stirring.

Step 3: Slowly add the polymer into solution again to gradually increasesolution viscosity. Repeat this step as needed until the polymer iscompletely dissolved and reasonable solution viscosity is developed.

Step 4: Apply ultrasonic mixing to suspension solution for 15-30 min tofurther disperse all the bioceramic particles uniformly into the PLLAsolution.

Step 5: Slowly combine or emulsify organic phase with aqueous phase.

Step 6: Additional aqueous phase material is added to leach out solvent.

Step 7. Collect the precipitated bioceramic particles/polymer compositemixture.

Example 3 Solution Blending of PLLA/HAP Composite (100:1 wt/wt)

Step 1: Added 50 mg HAP particles into 300 mL of chloroform and stirredfor 10-30 minutes to form bioceramic particle suspension solution.

Step 2: Slowly added 5 g PLLA into suspension solution and stirred about8 hours to dissolve all polymer.

Step 3: Applied ultrasonic mixing to suspension solution for 15-30 minto further disperse HAP particles into PLLA solution.

Step 4: Added suspension solution to 1 L methanol to precipitate polymerand particles.

Step 5: Filtered the precipitate and dried about 8 hours in vacuum ovenat 60° C. End product is PLLA/HAP composite. Composites were also madewith 2 wt % and 5 wt % HAP.

Mechanical Properties and Morphology of PLLA/HAP Composite (100:1 wt/wt)

Tensile testing of the composite samples and a pure PLLA were performedusing an Instron tensile tester obtained from Instron in Canton, Mass.Test samples were prepared by hot pressing the PLLA/HAP composites andpure polymer to a thin film at 193° C. for 30 seconds. Testing bars werecut from the thin film and tested. The peak stress at break, the strainat break, and the Young's modulus were measured. The draw rate was about0.5 in/min.

FIGS. 7-9 illustrate tensile testing results for pure PLLA and PLLA/HAPcomposites with 1 wt % HAP. FIG. 4 depicts the peak stress for the twosamples. PLLA/HAP composites have a higher peak stress than the purePLLA. FIG. 5 depicts the % strain at break for the two samples. The 1 wt% composite had a higher % strain at break than the pure PLLA. FIG. 6depicts Young's modulus for the two samples. The 1 wt % samples had ahigher Young's modulus than the pure PLLA.

Example 4 Solution Blending of PLLA/HAP Composite (2:1 wt/wt) as HAPIntermedium Mixture

Step 1: Added 25 g HAP particles to 3 L chloroform and stirred for 10-30minutes to form bioceramic particle suspension solution.

Step 2: Slowly added 50 g PLLA into suspension solution and stirredabout 8 hours to dissolve all polymer.

Step 3: Applied ultrasonic mixing for 15-30 min to further disperse HAPparticles into PLLA solution.

Step 4: Added suspension solution to 9 L methanol to precipitateparticles and polymer.

Step 5: Filtered the precipitate and dried about 8 hours in vacuum ovenat 60° C. End product is PLLA/HAP composite.

Extrusion of Precipitated PLLA/HAP (2:1 wt/wt) with PLLA

Step 1: Broke 2:1 wt/wt composite into small pieces

Step 2: Mixed 24 g of broken up composite and 376 g PLLA.

Step 3: Extruded mixture at 216° C.

Example 5 Extrusion of Precipitated PLGA/HAP (2:1 wt/wt) with PLGA

Step 1: Broke PLGA/HAP composite into small pieces

Step 2: Mixed 12 g broken up PLGA/HAP composite and 396 g PLGA.

Step 3: Extruded mixture at 216° C.

Example 6

As discussed above, to further improve mechanical properties of abioceramic and polymer composite, the interfacial adhesion can beenhanced. The adhesion between bioceramic particles and a biodegradablepolymer can be improved by coating at least a portion of the surfaces ofthe bioceramic particles with an adhesion promoter such as3-aminopropyltrimethoxysilane and 3-aminopropyltriethoxysilane.

Example of the Modification of HAP:

Step 1: Added 100 ml distillated water to 1900 ml Ethanol and stirredfor 15-30 min.

Step 2: Added 20 g 3-aminopropyltrimethoxysilane to water-ethanolmixture and stirred for 1 h.

Step 3: Added 20 g HAP and stirred for 2 h.

Step 4: Centrifuged the modified HAP from solution.

Step 5: Dried HAP about 8 hours in vacuum oven.

Example 7

A stent was fabricated from a PLGA/nanoparticle composite tubing. Priorto cutting a stent pattern, the tubing was expanded at 109° C. in a blowmolder to increase radial strength. A stent pattern was cut in theexpanded tubing using an ultra-fast pulse laser. The stent was crimpedat 30° C. After crimping, the stent was cold sterilized.

Example 8

The mechanical properties of a stent fabricated from a PLGA/nanoparticleHAP composite were tested on an Instron compression tester. The recoilof stents was recorded after inflation and deflation of stent.

FIGS. 10 and 11 illustrate compression testing results for PLGA/HAPstent (100:1 wt/wt). The compression testing results for 100% PLGA isalso included for comparison. FIG. 7 shows that the average radialstrength of PLGA/HAP stent is about 11% higher than that of the 100%PLGA stent. FIG. 8 shows that the compression modulus of PLGA/nano HAPstent increased by about 23% over the 100% PLGA stent.

FIG. 12 shows the recoil of PLGA/nano HAP stent is about 15% less thanthe PLGA stent.

Example 9

Stents were fabricated from a bioceramic/polymer composite with a matrixof PLGA copolymer. Calcium sulfate nanoparticles, which were pretreatedby PEG-PPG-PEG surface modifier, were mixed with the copolymer matrix.PEG refers to polyethylene glycol and PPG refers to polypropyleneglycol. The copolymer had 85 wt % L-lactide and 15 wt % GA. Thecomposite was fabricated according to methods described herein. Thestents were fabricated from tubes made from the composite and the tubeswas radially expanded. The expanded tubes were laser cut to form stents.

Stents were fabricated and tested having a ratio of copolymer toparticles of 100:1 by weight. Five stent samples were used for eachtesting (compression, recoil or expansion testing). at a zero time point(after fabrication) and after 16 hours of accelerated aging. Acceleratedaging refers to aging at 40° C.

The zero time point samples were subjected to compression testing.Compression tests were performed with an Instron testing machineobtained from Instron in Canton, Mass. A stent sample was placed betweentwo flat plates. The plates were adjusted so that the distance betweenthe plates was the diameter of the stent in an uncompressed state. Theplates were then adjusted to compress the stent by 10%, 15%, 25%, and50% of the uncompressed plate distance. A resistance force, the amountforce in units of Newtons/mm that was necessary to keep the stent ateach compression distance, was measured. The resistance forcecorresponds to a measure of the radial strength (Rs). The modulus wasalso measured. Table 1 provides the compression test results for the100:1 samples at zero time point. The Rs and modulus correspond to 50%compression.

TABLE 1 Compression test results for 100:1 samples at zero time point.Stent # Rs (psi) Modulus (psi) 1 5.867 365.5 2 5.443 291.5 3 6.027 316.94 5.879 324.2 5 5.539 310.1 Avg 5.751 321.6 Std dev 0.248 27.360

The stent samples were subjected to recoil testing at both time pointsfor each bioceramic composition. Each stent sample was deployed inside alength of Tecoflex elastic tubing. Tecoflex tubing can be obtained fromNoveon, Inc., Cleveland, Ohio. The inside diameter (ID) of the Tecoflextubing was 0.118 in and the outside diameter (OD) was 0.134 in. The IDof the sheath to hold the stent after crimping was 0.053 in. The stentswere deployed to an outer diameter of 3.0 mm by inflating the balloon.The balloon was deflated, allowing the stent to recoil. The diameter ofthe recoiled stent was then measured.

The percent recoil was calculated from:

% Recoil=(Inflated Diameter−Deflated Diameter)/Inflated Diameter×100%

The Inflated Diameter is the diameter of a deployed stent prior todeflating the balloon and the Deflated Diameter is the diameter of therecoiled stent. The deployment of the stent also results in an increasein length of the stent. The percent change in length was calculatedfrom:

% Length change=(Crimped length−Deployed length)/Crimped length×100%

Table 2 provides the results of the recoil test for the five 100:1 stentsamples at zero time point. As shown in Table 1, the outside diameter(OD) of the stent when the balloon was inflated and deflated wasmeasured at a proximal end, a middle, and distal end of the stent. ODwtrefers to the outside diameter with tecoflex tubing and ODS refers tothe outside diameter with stent only. The % Total Recoil given is theaverage of the recoil calculated at each point along the length of thestent.

TABLE 2 Recoil test results for 100:1 stent samples at zero time point.Crimp Inflated @ 8 atm Deflated Dimensions Tecoflex Tecoflex Prox MidDistal Prox Mid Distal % % DWT DWT Stent L Stent L OD OD OD Stent L ODOD OD Total Length Stent # Prox Dist (mm) (mm) (mm) (mm) (mm) (mm) (mm)(mm) (mm) Recoil Change 1 0.375 0.370 12.796 12.384 3.690 3.774 3.80212.392 3.448 3.504 3.529 7.7% 3.2% 2 0.368 0.378 12.833 12.529 3.7923.785 3.811 12.450 3.541 3.487 3.496 8.4% 3.0% 3 0.368 0.374 12.81712.553 3.835 3.886 3.871 12.720 3.618 3.561 3.519 8.5% 0.8% 4 0.3750.370 12.863 12.492 3.792 3.806 3.871 12.774 3.653 3.673 3.644 4.8% 0.7%5 0.365 0.370 12.793 12.421 3.803 3.815 3.856 12.407 3.579 3.576 3.6406.5% 3.0% ODwT 3.813 3.565 AVG 7.2% 2.1% ODS 3.441 3.193 Std 1.6% 1.3%Dev

The stents were subject to expansion testing at both time points. Eachstent sample was deployed to an outer diameter of first 3.0 mm, then 3.5mm, and then 4.0 mm. The number of cracks in the stents were counted ateach deployment diameter.

Table 3 provides the number of cracks observed in the 100:1 stentsamples at zero time point when deployed at a diameter of 3.5 mm. Thecolumns refer to the size of the cracks: “Micro” refers to micro-sizedcracks, “<25%” refers to cracks less than 25% of the strut width, “<50%”refers to cracks less than 50% of the strut width, and “>50%” refers tocracks greater than 50% of the strut width. “A” refers to the “v-shaped”region or bending region of struts and “B” refers to a spider region atthe intersection of 5 struts. The regions can be seen in FIGS. 13A-D. Nobroken struts were observed at either 3.5 mm or 4.0 mm deploymentdiameters. FIGS. 13A-D depict photographic images of the 100:1 stentsample 1 at zero time point before expansion, expanded to 3.5 mm, afterrecoil, and after expansion to 4.0 mm, respectively.

TABLE 3 Number of cracks observed at 3.5 mm deployment for 100:1 stentsamples at zero time point. Stents Deployed to 3.5 mm Stent # Micro <25%<50% >50% 1 A 4 2 B 2 A 2 B 3 A 4 B 4 A B 5 A 1 B

Test Results for 100:1 Stent Samples at 16 Hours of Accelerated Acing

Table 4 provides the results of the recoil test for the 100:1 stentsamples at 16 hours of accelerated aging. Tables 5A-B provide the numberof cracks observed in the 100:1 stent samples at 16 hours of acceleratedaging when deployed at a diameter of 3.5 mm and 4.0 mm, respectively. Nobroken struts were observed at either deployment diameter. FIGS. 14A-Ddepict photographic images of the 100:1 stent sample 1 at 16 hours ofaccelerated aging before expansion, expanded to 3.5 mm, after recoil,and after expansion to 4.0 mm, respectively.

TABLE 4 Recoil test results for 100:1 stent samples at 16 hours ofaccelerated aging. Crimp Dimensions Inflated @ 8 atm Dimensions DeflatedDimensions Tecoflex Tecoflex Prox Mid Distal Distal % % DWT DWT Stent LStent L OD OD OD Stent L Prox OD Mid OD OD Total Length Stent # ProxDist (mm) (mm) (mm) (mm) (mm) (mm) (mm) (mm) (mm) Recoil Change 1 0.3720.377 12.683 12.133 3.900 3.834 3.836 12.311 3.508 3.520 3.522 9.8% 2.9%2 0.380 0.383 12.830 12.306 3.870 3.809 3.780 12.380 3.623 3.546 3.5846.8% 3.5% 3 0.374 0.372 12.924 12.574 3.845 3.804 3.783 12.620 3.4773.448 3.422 10.5% 2.4% 4 0.373 0.375 12.806 12.411 3.933 3.874 3.88112.486 3.526 3.508 3.508 10.8% 2.5% 5 0.381 0.382 12.745 12.358 3.8533.799 3.809 12.570 3.482 3.489 3.471 9.9% 1.4% ODwT 3.841 3.509 AVG 9.6%2.5% ODS 3.464 3.132 Std Dev 1.6% 0.8%

TABLE 5A Number of cracks observed for 100:1 stent samples at 16 hoursof accelerated aging deployed at 3.5 mm. Stents Deployed to 3.5 mm Stent# Micro <25% <50% >50% 1 A 2 1 B 1 2 A B 3 A 2 1 B 4 A 1 B 5 A 7 B 1

TABLE 5B Number of cracks observed for stents deployed at 4.0 mm for100:1 stent samples at 16 hours of accelerated aging. Stents Deployed to4.0 mm Stent # Micro <25% <50% >50% 1 A 6 1 B 3 1 2 A B 1 3 A 5 1 B 1 4A 1 1 B 2 1 5 A 4 2 B 1

Example 10

A stent was fabricated from a polymer/bioceramic composite. The matrixwas a PLGA copolymer. Calcium sulfate nanoparticles were mixed with thecopolymer matrix. The copolymer was 50 wt % L-lactide and 50 wt %glycolide. The ratio of copolymer to particles was 100:3 by weight. Thecomposite was fabricated according to methods described herein. A tubewas fabricated from the composite and the tube was radially expanded.The expanded tube was laser cut to form a stent. The expecteddegradation time for the composite stent is about 3-5 months.

While particular embodiments of the present invention have been shownand described, it will be obvious to those skilled in the art thatchanges and modifications can be made without departing from thisinvention in its broader aspects. Therefore, the appended claims are toencompass within their scope all such changes and modifications as fallwithin the true spirit and scope of this invention.

1. A method for fabricating an implantable medical device comprising:forming a suspension solution including a fluid, a polymer andbioceramic particles, wherein the polymer is dissolved in the fluid, andwherein the bioceramic particles are dispersed in the solution;evaporating at least some of the fluid to remove at least some of thepolymer from the suspension solution, wherein at least some of thebioceramic particles are removed with the removal of polymer to form acomposite mixture, the composite mixture comprising the removedbioceramic particles dispersed within the removed polymer; andfabricating an implantable medical device from the composite mixture. 2.The method according to claim 1, further comprising decreasing thepressure above the suspension solution below a vapor pressure of thefluid to facilitate the evaporation.
 3. The method according to claim 1,further comprising heating the suspension solution to facilitate theevaporation.
 4. The method according to claim 1, wherein the suspensionsolution comprises a surfactant.
 5. The method according to claim 1,wherein the medical device is a stent.
 6. The method according to claim1, wherein the polymer is biodegradable.
 7. The method according toclaim 1, wherein the bioceramic particles are nanoparticles.
 8. Themethod according to claim 1, wherein all or substantially all of thebioceramic particles are removed from the suspension solution.
 9. Themethod according to claim 1, wherein a ratio of the weight percent ofthe bioceramic particles to the polymer in the suspension solution is atleast about 1:200.
 10. The method according to claim 1, furthercomprising treating the bioceramic particles with an adhesion promoterprior to or after forming the suspension solution.
 11. The methodaccording to claim 1, wherein the bioceramic particles comprisehydroxyapatite or calcium sulfate.